Provider Demographics
NPI:1821495219
Name:CHRISTIANSEN, MORGAN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:
Last Name:CHRISTIANSEN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 PARK BLVD APT 3
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94606-1573
Mailing Address - Country:US
Mailing Address - Phone:707-812-8870
Mailing Address - Fax:
Practice Address - Street 1:2160 APPIAN WAY
Practice Address - Street 2:
Practice Address - City:PINOLE
Practice Address - State:CA
Practice Address - Zip Code:94564-2576
Practice Address - Country:US
Practice Address - Phone:510-724-1248
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-01
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41950225100000X
VA2305212734225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist